measles

and Martina Feichter, medical editor and biologist

Sophie Matzik is a freelance writer for the medical team.

More about the experts

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day.She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Measles is a highly contagious, febrile viral infection. It usually starts with flu-like symptoms before the typical measles rash develops. In most cases, measles will heal on its own without any problems. Sometimes complications such as middle ear infections, pneumonia or dangerous encephalitis also occur. Children under five and adults are particularly susceptible to this. Read everything you need to know about measles here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B05

Brief overview

What is measles? Highly contagious viral infection that is spread around the world. It is one of the "teething troubles", although adolescents and adults are also increasingly suffering from it.
Contagion: droplet infection, direct contact with infectious nasal or throat secretions from patients (e.g. by sharing cutlery)
Symptoms: In the first stage flu-like symptoms, a first flare-up of fever and whitish spots on the oral mucosa (Koplik spots). In the second stage, the typical measles rash (red patches flowing into one another, starting from the ears) and a second bout of fever.
Treatment: bed rest, rest, possibly anti-fever measures (such as anti-fever medication, calf compresses), cough suppressants, antibiotics (with additional bacterial infection)
possible complications: e.g. otitis media, pneumonia, bronchitis, diarrhea, pseudo croup (croup syndrome), brain inflammation (encephalitis); Long-term consequences: chronic encephalitis (subacute sclerosing panencephalitis, SSPE)
Prognosis: Measles usually heal without any problems. Complications occur in 10 to 20 percent of patients in this country. About one in 1,000 people can die.

Measles: contagion

The measles virus is transmitted on the one hand by droplet infection: infected people distribute tiny droplets of saliva containing the virus in the surrounding air when they speak, cough and sneeze. Other people can breathe these in: As soon as the viruses in the droplets of saliva come into contact with the mucous membranes in the respiratory tract, they can infect the new "victim". By the way: measles viruses can survive in the air for up to two hours!

On the other hand, measles can also be infected through direct contact with infectious secretions from the nose and throat of infected people. This happens, for example, when you use a patient's cutlery or drinking glass.

Measles viruses are extremely contagious! Of 100 people who have not yet had measles and have not been vaccinated against it, 95 fall ill after coming into contact with the measles virus.

How long are measles patients contagious?

Anyone who has been infected with measles is contagious three to five days before the typical measles rash occurs and up to four days afterwards. Infectiousness is greatest just before the rash breaks out.

Measles: incubation period

The time between infection with a pathogen and the appearance of the first symptoms is called the incubation period. It is usually eight to ten days for measles. The typical measles rash (second stage of the disease) usually appears two weeks after infection.

Measles: symptoms

Measles has two stages of the disease with two attacks of fever and other symptoms:

Precursor stage (prodromal stage)

The illness begins with a moderate fever, runny nose, sore throat, and dry cough. The face is puffy. Fatigue, headache and abdominal pain, constipation or diarrhea, and conjunctivitis with photophobia are also possible symptoms. Typical measles in the early stages are the so-called Koplik spots on the oral mucosa: These are circumscribed, small, red spots with a white center ("lime splatter spots"). From the 2nd or 3rd day of the illness, they develop primarily on the cheek mucous membrane in the area of the molars. From the 3rd day on, the entire mucous membrane of the mouth and throat becomes red. In addition, the fever rises sharply.

The precursor stage lasts for about three to four days. Towards the end, the fever initially drops again.

Main stage (exanthema stage)

In this phase of the illness, the fever rises sharply again. The typical measles rash develops: irregular, three to six millimeters in size, initially light red spots that flow into one another. They form behind the ears first and then spread all over the body. Only the palms and soles of the feet are left out. Within days, the spots turn darker, brownish-purple.

After four to seven days, the mase spots fade again in the same order in which they appeared (starting from the ears). This fading is often associated with flaking. At the same time, the other complaints also subside.

It takes about two weeks for the patient to recover. The immune system is weakened for a longer period of time: for around six weeks, there is an increased susceptibility to other infections.

Measles - course and contagion

Measles does not become noticeable for about nine days after infection. But they are contagious early on.

Mitigated measles

In newborns who still carry measles antibodies from the mother, a measles infection is usually weakened. Such "mitigated measles" can sometimes also be observed in other people. This includes, for example, patients who have not received the full measles vaccination and therefore have weak, incomplete vaccination protection. In mitigated measles, the typical rash is not fully developed. This can make diagnosis difficult. Yet those affected are contagious.

Measles: complications

Occasionally, measles infection has complications. Due to the weak immune system that lasts for several weeks, other pathogens such as bacteria have an easy time of it. The most common symptoms associated with measles are otitis media, bronchitis, pneumonia and diarrhea.

Severe inflammation of the larynx lining is also possible. Doctors also speak of croup syndrome or pseudocroup. Those affected have attacks of dry, barking coughs and difficulty breathing (or even shortness of breath), especially at night.

Foudroyant (toxic) measles are rare: The affected patients get a high fever and bleeding from the skin and mucous membranes. The mortality rate from this measles complication is high!

Another rare but feared complication is inflammation of the brain (encephalitis). It manifests itself around four to seven days after the onset of the measles rash with headache, fever and impaired consciousness (up to a coma). Around 10 to 20 percent of patients die. In another 20 to 30 percent, measles-related encephalitis causes permanent damage to the central nervous system.

Very rarely, an average of six to eight years after the measles infection, a fatal late complication occurs - a chronic inflammation of the brain known as subacute sclerosing panencephalitis (SSPE): measles viruses that have penetrated the brain multiply, causing irreversible nerve damage . First, changes in behavior become apparent. In the further course, neurological disorders such as muscle twitching and seizures as well as nerve failures come along. In the final stage, all brain functions fail - the patient dies.

Out of 100,000 measles patients, four to eleven get SSPE. Children under the age of five are particularly susceptible to this fatal sequela of measles. In this age group, there are an estimated 20 to 60 cases of SSPE per 100,000 measles patients.

In people whose immune system is suppressed by medication or another disease (immunosuppression) or who have a congenital defect, the external measles can be quite weak. The measles rash may be absent or look atypical. However, there is a risk of serious organ complications. This includes a progressive form of pneumonia (giant cell pneumonia). Sometimes a special type of encephalitis also develops (measles inclusion body encephalitis, MIBE): it kills about three in ten people.

Measles: causes and risk factors

Measles is caused by the highly contagious measles virus. The pathogen belongs to the paromyxovirus family and is distributed worldwide.

The disease is of particular importance in developing countries in Africa and Asia: measles are among the ten most common infectious diseases and are often fatal.

In Germany, the number of measles has fallen since the measles vaccination was introduced. For some years now, it has mostly been less than 2,000 cases per year. However, there are always regional or nationwide measles outbreaks for a limited time. In addition, it has been observed for some years that more and more adolescents and (young) adults are suffering from the "childhood disease".

Measles: examinations and diagnosis

The symptoms of the disease, especially the rash, give the doctor important clues about measles. However, there are some medical conditions with similar symptoms, namely rubella, rubella, and scarlet fever. In order to avoid confusion, a laboratory test must therefore confirm the suspicion of measles. Various tests can be used, with the detection of antibodies against measles virus being the most common:

Detection of specific antibodies against the measles virus: fastest and safest diagnostic method. The patient's blood is used as sample material (if brain inflammation is suspected, nerve water = liquor). The test is usually positive as soon as the typical measles rash shows up. Before that, however, the antibodies are sometimes not yet detectable.
Detection of the viral genetic material (measles virus RNA): For this purpose, a urine sample, saliva sample, tooth pocket fluid or a throat swab is taken. The viral traces of genetic material found in it are reproduced by means of the polymerase chain reaction (PCR) and can thus be clearly identified.
Cultivation of measles viruses: For this purpose, sample material (urine sample, saliva sample, etc.) is exposed to optimal growth conditions in order to cultivate the pathogens it contains. This is how they can be identified. This procedure is very time-consuming and is only used in special cases (for example in patients with a suppressed immune system).

Measles are notifiable!

Measles is one of the notifiable diseases. As soon as the first symptoms indicate measles, the doctor should be consulted. The doctor must report the suspicion, the actual illness and also the death from measles to the responsible health department (with the name of the patient).

If measles is suspected or has a proven infection, those affected must stay away from community facilities (schools, day-care centers, etc.). This also applies to employees of such facilities. Patients may not be admitted again at the earliest five days after the outbreak of the measles rash.

Measles: treatment

There is no specific therapy for measles. But they can alleviate the symptoms and support the healing process. This includes bed rest in the acute phase of the illness and physical rest. If the patient's eyes are sensitive to light, the patient's room should be slightly darkened - direct light should be avoided. Also make sure that the room is well ventilated and not stuffy.

Experts recommend measles patients to drink enough - especially if they have a fever and sweat. Instead of a few large servings, several small meals should be consumed throughout the day.

For example, calf compresses and, if necessary, antipyretic medication help against the fever. However, you should first discuss the use of the medication with a doctor. The same applies if you want to use cough suppressants (cough suppressants or cough suppressants).

The fever and pain reliever acetylsalicylic acid (ASA) is not suitable for children. In connection with febrile infections, the rare but life-threatening Reye's syndrome can otherwise develop!

In the event of an additional bacterial infection (for example in the form of otitis media or pneumonia), the doctor usually prescribes antibiotics.

If the measles causes Krupp syndrome or encephalitis, hospital treatment is necessary!

Measles: disease course and prognosis

Measles heals easily in most patients. However, complications occur in 10 to 20 percent of cases. Children under the age of five and adults over the age of 20 are particularly affected. Measles complications like this can also be fatal under certain circumstances. This is especially true for brain inflammation that develops either shortly after the infection or as late complications years afterwards.

Overall, according to the World Health Organization (WHO), the death rate from measles in developed countries such as Germany is up to 0.1 percent (1 death per 1,000 measles patients). It can be significantly higher in developing countries, for example due to malnutrition.

Lifelong immunity

You can only get measles once in your life: Anyone who has survived an infection is protected from being infected again with measles virus for life. In the event of an infection, the immune system produces specific antibodies against the pathogen. Some of it remains in the body even after healing. If there is later contact with the measles virus, the antibodies are activated immediately and eliminate the intruder.

Pregnant women who have antibodies against measles also transmit them to the unborn child via the umbilical cord. The maternal antibodies remain in the child's body for a few months after birth and thus prevent infection. This so-called nest protection lasts until about six months of age.

Measles vaccination

A measles disease can cause permanent damage to the nervous system and even lead to death - in 2018 around 140,000 people worldwide died of measles, most of them children under the age of five. This is why the measles vaccination is so important:

It is generally recommended for all infants and toddlers: You should be vaccinated against measles twice within the first two years of life. If the offspring is to attend a community facility such as a daycare center, the measles vaccination has even been mandatory since March 1, 2020 (unless the measles disease they have experienced can be proven with a medical certificate).

The measles vaccination is either recommended or even prescribed for other groups of people. You can read more about this as well as about the implementation and possible side effects of the vaccination in the article Measles vaccination.